Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey

Hospital Exam RoomThere is a critical need to redesign our health-care system to better serve the needs of older adults.  Research has identified specific ways in which the health care system could improve to prioritize these needs. This includes working towards broad goals, such as improved care continuity that has been shown to result in lower hospital utilization for older adults with multiple chronic medical conditions. 

Julia Adler-Milstein, PhD, as part of a team of researchers at Harvard School of Public Health and UCSF, conducted the first national hospital survey to measure adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. Results are reported in a new article published in the Journal of the American Medical Informatics Association. 

The 4Ms Framework is a set of evidence-based priorities designed to shift approaches to care for older adults by focusing on What Matters, Medication, Mentation, and Mobility. What Matters refers to the alignment of individuals’ specific health outcome goals and care preferences with their care plans. Medication refers to reductions in unnecessary medication use and specific attention to the use of medications that could interfere with patient care goals, mobility, or mentation. Mentation refers to the commitment to preventing, identifying, treating, and managing dementia, depression, and delirium. Mobility refers to the goal of ensuring that adults move safely and can maintain or improve function. 

“Our results identify for hospitals which capabilities are relevant to caring for older populations, and it may help them prioritize which ones to pursue by knowing how widely adopted they are,” said Adler-Milstein.

The authors found that 64.0 percent of hospitals had structured EHR documentation of the 4Ms fully implemented in at least one unit and 41.5 percent had these fully implemented across all units. Structured documentation of medications was the highest (91.3 percent in at least one unit) and structured documentation of mentation was the lowest (70.3 percent in at least one unit). We found that 16.2 percent of facilities had implemented all exchange/communication functions in at least one unit and 7.6 percent of hospitals had implemented across all units. Less than half of hospitals had an EHR portal for long-term care facilities to access hospital information (45.4 percent in at least one unit), sent information electronically to long-term care facilities (44.6 percent), and had training for adults/caregivers on the patient portal (32.1 percent). “Unfortunately, lack of connectivity between acute and post-acute settings is a known problem.  We have seen the many ways in which lack of connectivity has hampered COVID response and so hopefully we won’t waste the current crisis by continuing to underinvest in this capability,” Adler-Misltein said. “Hospital-post acute care information sharing is particularly critical because of COVID prevalence in nursing homes and also just how sick patients are when they make this transition.”

Their results offer the first assessment of US hospital implementation of age-friendly EHR functions. Despite the substantial national investment in hospital EHR adoption, implementation has not focused on the specific capabilities to support the care of older adults who comprise the majority of the inpatient population. It is, therefore, unlikely that use of EHRs is resulting in optimal gains in health outcomes for older adults. To address this, it is critical that policy and practice-based efforts, particularly those focused on the care and outcomes for older adults, promote stronger incentives that reward hospitals for such investments. “We need to make the case for investing in these capabilities by tying them to outcomes and showing how the IT helps deliver better care for older patients, “said Adler-Milstein.

Julia Adler-MilsteinJulia Adler-Milstein, PhD

Dr. Adler-Milstein is a leading researcher in health IT policy, with a specific focus on electronic health records and interoperability. She has examined policies and organizational strategies that enable effective use of electronic health records and promote interoperability.  Dr. Adler-Milstein the inaugural director of the Center for Clinical Informatics and Improvement Research.

Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey. 
Adler-Milstein J, Raphael K, Bonner A, Pelton L, Fulmer T. J Am Med Inform Assoc. 2020 Aug 9:ocaa129. doi: 10.1093/jamia/ocaa129.